Medical Matters: Is Vaping safer than smoking?

50 years on from the first official smoking warning, do e-cigarettes offer a safe alternative?

Last week saw the 50th anniversary of the publication of the report of the US surgeon general which officially, and for the first time, highlighted the serious health consequences of smoking.

Commenting on the significance of Dr Luther Terry’s 1964 report, the chairman of Ash Ireland, Dr Ross Morgan, said: “This ground-breaking report not only provided new and irrefutable medical evidence of the harm caused by smoking, but also commenced an informed public debate on smoking . . .

“In 1958, only 44 per cent of Americans believed that smoking caused cancer, while in 1968, four years after the report was published, 78 per cent believed that smoking was a cause of cancer.”

Smoking banThere has been much water under the bridge since then. Ireland played a leading role in the worldwide implementation of the smoking ban in public places.

And the battle with the tobacco industry continues as it fights a rear-guard action against the introduction of standardised packaging across all cigarette brands.

But the tobacco industry is also looking ahead. It is investing heavily in what it sees as the future of smoking: electronic cigarettes.

E-cigarettes do not contain tobacco. Instead they contain a cartridge filled with nicotine that has been dissolved in water.

Add in a battery and a heating element designed to turn the liquid into nicotine-laced vapour and the “vaper” (as the consumer of e-cigarettes is popularly known) gets a noticeable nicotine “hit” with each puff.

No harmful tar or carbon monoxide to worry about and, so far, no real regulatory concern.

Evidence about the use of e-cigarettes is still being gathered but no evidence has yet emerged of the transfer to the consumer of tar and some of the other harmful chemicals contained in traditional smoke.

Another major selling point for manufacturers is the absence of second-hand smoke to affect those around the “vaper”.

Long-term health effectsAccording to proponents, this means e-cigarettes can be consumed in pubs, concert halls and cinemas, so no more skulking outside these venues in the pouring rain.

However, the British Medical Association, among others, disagrees, and has called for e-cigarettes to be included in the ban on smoking in public places.

They still contain nicotine of course and because e-cigarettes are seen as safer than traditional tobacco products, there is a concern that users will readily consume more nicotine because of the reusable nature of the electronic version.

Little research has been done into their long-term health effects. There is no evidence to suggest that nicotine is carcinogenic but it is an addictive substance. And in very high doses it is toxic, producing measurable effects on the cardiovascular and metabolic systems.

A major marketing angle for e-cigarettes is their potential use as a bridge for existing smokers wishing to give up tobacco cigarettes.

However, there is genuine concern among public health advocates that those switching will merely swap one addiction for another.

But a recent study published in The Lancet showed that some six months after starting to use e-cigarettes, a little over 7 per cent of traditional smokers had stopped smoking tobacco. This compares favourably with people who use nicotine patches as an aid to stopping smoking.

With the tobacco industry’s track record of obfuscation and hiding evidence of the harmful effects of smoking over many decades, there is widespread distrust of its claims that it will not be marketing e-cigarettes to children and adolescents. The production of vanilla and other flavoursome e-cigarettes doesn’t engender confidence. And if children and teenagers see e-cigarettes in widespread use, will this encourage some to take up tobacco smoking?

The ultimate fate of e-cigarettes is far from clear. Could they end up being regulated as medical devices? Or will they eventually be embraced by doctors as a lesser evil than the tobacco products so effectively popularised by the iconic Marlboro Man cowboy advertisements ?

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